In each state, we asked whether implementing ELE took resources away from other activities, or whether other activities were postponed or deprioritized to accommodate ELE. For most ELE programs, the answer was ‘no;’ staff could not recall whether there were opportunity costs for Iowa CHIP’s ELE program. However, Louisiana and Iowa Medicaid reported substantial opportunity costs; these are the same states that spent the most on programming and implemented the most automated ELE mechanisms. For example, Louisiana delayed streamlining its online application process and delayed increased collaboration with the state’s Department of Corrections because of ELE. Both of these activities might have resulted in increased Medicaid enrollments.